Smoking Bans in US Hospitals

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Abstract
Objective. —To examine compliance and characteristics of hospitals with tobacco control standards enacted by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Design and Setting. —On-site national survey of hospitals as part of routine JCAHO accreditation visits. Participants. —A total of 3327 US hospitals received site visits in 1992 and 1993 and were matched with American Hospital Association Annual Survey of Hospitals data. Main Outcome Measures. —Compliance or noncompliance with tobacco control standards; location in a tobacco-producing state; and organizational characteristics, including provision of psychiatric/alcohol—chemical dependency services. Results. —Two years after implementation, 95.6% of hospitals met the new JCAHO smoking ban standard; 90.9% of hospitals were in compliance with a second smoking standard requiring development and use of medical criteria for physician-ordered exceptions to the ban. Hospitals in tobacco-producing states had higher-than-average rates of compliance when compared with hospitals in other states. Hospitals providing psychiatric and/or substance abuse services had lower-than-average rates of compliance. Conclusion. —This first industry-wide smoking ban has been successful. However, hospitals should consider evaluating the use of medical exceptions to this policy. (JAMA. 1995;274:488-491)

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